Due to the Carona Virus, our office will be operating remotely in order to keep our staff free from infection. For latest update on the virus as it pertains to Florida please access our link. Office: 813.995.6013 Ext: 101 / Direct: 727.755.3060 Email: info@centurioninsuranceafs.com

Commercial Auto Quote

Please complete the details below in order to obtain your Quote. We will have a Personal Protection Specialist contact you. 








NoneICCDMVOther


Intrastate (CA only)0-100 MILES101-200 MILES201-300 MILES301-500 MILESIntrastate-Exactly where?

Driver Information













*Specify the number of year’s commercial driving experience each driver has. If there are any drivers with a “not at fault” accident, please provide a copy of the policy report with your submission

EQUIPMENT:

EQUIPMENT(E1)







EQUIPMENT(E2)







EQUIPMENT(E3)







EQUIPMENT(E4)







*If there are 5 or more power units, please provide a completed ACORD or completed company application instead of this form for quoting.

TRAIER(S):

TRAIER(T1)







TRAIER(T2)







TRAIER(T3)







TRAIER(T4)







*Please specify if applicant is pulling non-owned trailers and if applicant is pulling doubles.

COVERAGES:*


$100K CSL$300K CSL$500K CSL$750K CSL$1M CSL$500AUTO LIABILITY DEDUCTIBLE:OTHER

$15,000/$30,000$25,000/$50,000$30,000/$60,000CARGO$25,000$50,000DEDUCTIBLE:

DEDUCTIBLE:

PRIOR INSURANCE HISTORY FOR THE PAST 3 YEARS:

POLICY PERIOD


LIABILITY LOSSES


LOSSES


*If any prior losses, please provide a copy of currently valued loss runs.






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